Provider Demographics
NPI:1497906432
Name:BETANCOURT ALBRECHT, MARION E (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:E
Last Name:BETANCOURT ALBRECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WEST MEETING ST SUITE 205
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6209
Mailing Address - Country:US
Mailing Address - Phone:803-285-8080
Mailing Address - Fax:803-285-9898
Practice Address - Street 1:901 WEST MEETING ST SUITE 205
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6209
Practice Address - Country:US
Practice Address - Phone:803-285-8080
Practice Address - Fax:803-285-9898
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31279207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC312799Medicaid
SCGP5708Medicaid